Disparities in management guidelines for gastrointestinal stromal tumors: A comparison of recommendations from the Chinese Society of Clinical Oncology, National Comprehensive Cancer Network, and European Society for Medical Oncology

Gastrointestinal stromal tumors (GISTs) are the most common soft tissue sarcomas of the gastrointestinal tract, with most cases harboring oncogenic driver mutations in the KIT proto-oncogene receptor tyrosine kinase (KIT) or platelet-derived growth factor α (PDGFRA). The advent of targeted therapy, notably the first tyrosine kinase inhibitor (TKI) imatinib, has revolutionized the treatment landscape for GISTs. Recent advancements and emerging evidence in the diagnosis, treatment, and assessment of treatment response to TKIs in GISTs have led to updates to major clinical practice guidelines, including the latest guidelines from the Chinese Society of Clinical Oncology (CSCO, 2024), the US National Comprehensive Cancer Network (NCCN, version 1.2025), and the European Society for Medical Oncology (ESMO, 2022). Although these guidelines align on fundamental principles, some key differences in recommendations exist. This commentary highlights discrepancies in the recommendations for managing GISTs as outlined in these major guidelines. Based on emerging new evidence from recent studies, the authors propose recommendations to be considered for inclusion in future guideline updates to optimize management strategies and ultimately improve the outcomes of patients with GISTs.